The Adherence Fight: A TKO?

Healthcare professionals have been fighting an endless equivalent to the inspirational Rocky Balboa parable—with the exception that in this epic the ending remains unscripted.

A first glance at the current data screen actually suggests that patient adherence is getting worse, not better. New data from the Center for Health Transformation claims the annual cost of patients not taking their medicines as prescribed is nearly $300 billion, with approximately 125,000 patients dying each year due to poor adherence—that's 342 people every day. But the engagement of new stakeholders, tighter focus on wellness and prevention, and the development of better performance metrics to drive internal support for adherence programs could be adding the bulk the healthcare industry needs to finally make it a fair fight.

"I refer to this as the silent disease in America because of the large amount of non-adherence to medications, routinely in acute care situations but even more specifically in chronic disease," said Dr. Lyle Bootman, Dean and Professor at the University of Arizona School of Pharmacy in a recent adherence teleconference. "Not only is this a clinical problem in terms of [patient] outcomes ... it has serious economic consequences for this country. That $300 billion cost of non-adherence is in the same category and level of severity as heart disease and cancer, which are in the range of $250 billion to $350 billion to manage and diagnose. So, indeed, adherence, when looked upon as a disorder, is a very serious clinical and economic problem."

What is the true issue driving non-adherence? Shouldn't patients—especially those with chronic or more severe diseases—want to take their medication and feel better? Consensus is proving elusive; a variety of excuses exist. Patients start to feel better so they stop taking their scrips as often; they can't handle the unpleasant side effects; the copays are too expensive; or they just forget.

HealthPrize—an organization that provides pharmaceutical companies and other organizations with online adherence-incentive programs—scoffs at these factors as excuses that mask the true root of the problem. Its blunt and rather frightening conclusion is that medication non-adherence is often intentional. "Upon greater digging, it becomes clear that forgetfulness can also serve as a convenient excuse rather than a true reason," reads HealthPrize's recent white paper, "Medication Non-Adherence: An Ancient Problem in Need of Modern Solutions." "There are many deeper cultural reasons ... such as: taking medication is not a high enough priority; taking medication makes a person feel old; it reminds a person that they have a 'condition' or that they're a 'patient;' they don't trust their doctor; or they just don't like the idea of taking a pill."

If there's any doubt as to the validity of such a statement, consider the vast number (more than 20 percent according to a study from Harvard Medical School last year) of patients who receive a first-time scrip from their physician and then never even make it to the pharmacy to fill the initial prescription. These patients have made an active decision not to take a medication—despite a recent appointment and discussion with their doctor, whose advice they presumably willingly sought out to manage their condition.

DIMENSIONS OF PATIENT ADHERENCE (Source: Capgemini Consulting)

A survey and white paper—"Patient Adherence: The Next Frontier in Patient Care"—from Paris-based Capgemini Consulting found that "on average, adherence levels drop over the course of the patient journey from 69 percent of patients filling their first prescription to 43 percent continuing their treatment as prescribed after six months." Additionally, the paper says, "It is also estimated that non-adherence results in an average per-drug loss of 36 percent in potential sales for a pharma company."

Patient cost is also a theme, one that remains largely unspoken. A survey conducted in September 2010 by MDLinx and parent company M3 revealed that 95 percent of the nation's oncologists reported a rise in their patients' concerns over treatment costs in the six months prior to the survey. Of the 106 US oncologists surveyed, 84 percent said they had invested more time and effort into the financial planning of patients' treatments than they ever had before. Additionally, 67 percent of those who responded reported that their patients were rationing medications and/or forgoing treatment due to financial and insurance coverage concerns.